经左颈静脉插管肝内门-体静脉分流术的应用解剖

为给临床经左颈静脉插管行肝内门 -体静脉支架分流术提供解剖学依据 ,在 4 8例成人尸体上解剖并观测了双侧颈内静脉、头臂静脉、上腔静脉、右心房、下腔静脉上段的长度、外径、以及各有关静脉间的角度。结果为左颈内静脉长度 :10 6.9± 18.3 m m,外径 :13 .6± 3 .4 mm ;左头臂静脉长度 :66.3± 10 .8mm ,外径 :15 .9± 4 .1mm;上腔静脉长度 :4 8.5± 9.8mm,外径 :2 1.4± 8.4 mm;右心房长度 :68.7± 17.4 m m,上口外径 :2 0 .2± 4 .7mm,下口外径 :2 3 .9± 6.0 m m;下腔静脉上段长度 :2 1.5± 6.5 m m;左颈内静脉延长线与左头臂静脉间的角度 :4 5 .5°± 10 .3°,左头臂静脉延长线与上腔静脉间的角度 :5 8.3°± 12 .7°;5 8.3°± 12 .7°;左颈内静穿刺点至肝静脉口的总长 :2 4 3 .2± 2 3 .6m m。结论 :在经左颈内静脉行肝内门 -体静脉分流术时只要掌握了插管静脉的角度和深度仍具备和右侧穿刺途径一样多的优点

Applied Anatomy of Intervenient Technic of InterhepaticPortosystemicstent Shunt Through Left Jugular Approach

The paper aims are to provide the anatomic data for intervenient technic through left transjugular approach for interhepatic portosystemic stent shunt (TIPSS). The two sides of intenal jugular vein, brachiocephalic vein, and superior cena cava, right atrium, superior part of inferior vena cava were studied on 48 adult cadavers. The leng ths of left internal jugular vein, left brochiocephalic vein, superior vena cava, right atrium and superior part of inferior venacava were 106.7±18.3mm, 66.3±10.8mm, 48.5±9.8mm, 68.7±17±74mm, 21.4±6.5mm respectiely; the total length from injective dot of left internal jugularvein to the orifice of hepatic vein was 243.2±28.6mm. The angles between left internal jugular and brachiocephalic vein was 45.5°±10.3°,between left brachiocephalic vein and superior vena cava was 58.3°±12.7° separately. There are as advantage as right when TIPSS was made carefully to contral deepth and angles of the intravenous intubation.